不同临床时期哮喘患者小气道功能的变化及其临床意义

摘要

目的：：观察各临床时期哮喘患者小气道功能的变化,探讨其临床意义.方法：随机选择确诊为支气管哮喘的患者127例,并用常规方法测定肺功能.按肺功能结果分为A、B、C 3组.A 组34例,为首次哮喘急性发作患者；B 组93例,为曾诊断为哮喘但受试时处于哮喘缓解期患者例.对照组为 C 组,为健康志愿者20例.统计并分析上述各组首秒钟的竭力呼吸指数(FEV1)、吐气竭力肺活量50％时的瞬间流量(FEF50％)、呼出肺活量总指数的70％以上时的的瞬时气流速率(FEF75％),并比较各组行支气管舒张试验后的FEV1改善率(ΔFEV1)、FEF75％改善率(ΔFEF75％)和 FEF50％改善率(ΔFEF50％).结果：A、B组小气道功能多数有异常,且与 C 组相比有统计学差异(P＜0．01).除 C 组外,A,B 组ΔFEF75％、ΔFEF50％均较ΔFEV1改善显著,差异有统计学意义(P＜0．05).结论：急性期哮喘患者均存在小气道功能异常,而缓解期哮喘患者多数存在小气道功能异常.行舒张试验后,无论急性期或缓解期哮喘患者,其大小气道功能均有改善,但小气道功能的改善弱于大气道作用的提升.敬告不同时间段的哮喘呼吸道病状时刻潜在,治疗过程需要循序渐进.%[ABSTRACT]Objective:To obsearve the small airways function changes of asthmatic patients in different clinical phases and to discuss its clinical significance.Methods:A total of 127 patients who have already been diagnosed as asthma were select-ed randomly and pulmonary function (PF)of them was determined by conventional method.Then they were divided into A,B and C group based on PF results.A group of 34 patients suffered from acute asthma attack for the first time.B Group of 93 pa-tients was diagnosed as asthma but in remission phase.C Group was regarded as Control group with 20 healthy volunteers. Then FEV1 ,FEF5 0 %,FEF7 5 % levels of patients in each group were analyzed,andΔFEV1 ,ΔFEF7 5 % andΔFEF5 0 % levels of patients in each group were compared after bronchial dilation test.ResuIts:Most patients in group A and B had abnormal small airways function,and their small airways function had significant difference compared with that of group C (P<0.01).In addi-tion,except for group C,ΔFEF7 5 %,ΔFEF5 0 % levels in A and B group were improved obviously than ΔFEV1 levels ,and difference had statistical significance (P<0.01).ConcIusions:Asthma patients in acute phase all had abnormal small airways function.Most asthma patients in remission phase also had anbnormal small airways function.After bronchial dilation test, whether patients in acute phase or in remission phase,major and small airways function of them were improved,but improve-ment of small airways function was weaker than that of major airways.This indicated that asthma respiratory tract symptoms in different phases existed all the time and so therapeutic process was needed to perform step by step.